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Flashcards in CAL: Chemotherapy Deck (24):
1

What lymph nodes which should be palpated during your clinical examination

• Mandibular / Submandibular • Pre-scapular • Axillary • Popliteal • Inguinal / Superficial Inguinal

2

What are causes of generalised lymphadenopathy

• Infection • Immune-mediated disease • Neoplasia (primary or secondary)

3

What are essential diagnostic tests to run if you suspect lymphoma?

Serum biochemistry Urinalysis FNA

4

Why is it best to avoid the submandibular LNs?

reactive changes due to dental disease might complicate the interpretation. (Increased numbers of immature cells can occur in a highly reactive node). It is best to sample more than one node if possible.

5

What is the biggest problem from these biochemistry results (high albumin, high calcium, high urea, high creatinine, high lipase)?

hypercalcaemia as this can lead to renal failure, depression, vomiting, constipation, weakness, muscle twitching and dysrhythmias (bradycardia).

6

Why does hypercalcaemia occur in lymphoma?

In lymphoma, PTHrP is released  hypercalcaemia.

7

How do you correct hypercalcaemia?

initially administer 0.9% NaCL IV at 6ml/kg/hour. If this fluid therapy is insufficient to reduce the calcium, besides giving treatment for the underlying disease (lymphoma), there are 2 different types of drugs that you could give to help lower the calcium levels: furosemide/ fruesemide OR 2 Bisphosphonates such as pamidronate

8

How does furosemide correct hypercalcaemia?

This diuretic stimulates renal excretion of calcium. It should only be used after making sure that the patient is fully hydrated. Cheap and effective. When lymphoma treatment is started, the calcium will usually decrease.

9

How do bisphosphonates such as pamidronate correct hypercalcaemia?

Bisphosphonates are osteoclast inhibitors and would reduce calcium levels. They are usually only used in refractory cases of hypercalcaemia, or when there is a delay in reaching a diagnosis. When treatment for lymphoma is started the calcium will usually decrease.

10

How does calcitonin correct hypercalcaemia?

This drug reduces calcium by antagonising the actions of PTH or PTH-rP. Usually only used in refractory cases of hypercalcaemia, or when there is a delay in reaching a diagnosis. When treatment for lymphoma is started, the calcium will usually decrease.

11

How often should you monitor a chemotherapy patient?

every week during the induction phase to check for any adverse effects of the chemotherapy (myelosuppression).

12

Does a TC or BC lymphoma have a better prognosis?

TC lymphoma generally has a poorer prognosis than BC lymphoma and the remission duration and survival is generally about half that of a BC lymphoma.

13

Define MST

median survival time

14

What is the MST of a canine BC lymphoma treated with COP?

6 - 12 months, depending on the rescue protocol(s) used

15

What chemo protocol is currently being investigated to improve TC lymphoma prognosis?

the RVC modified LOPP protocol (lomustine, vincristine, procarbazine and prednisolone).

16

What level do platelets need to be in order for there to be a clotting problem?

unlikely to cause a bleeding disorder unless it falls below 30-50 x10^9/l

17

Why might you get a high ALP on biochemistry from a dog on COP chemo protocol?

not unexpected since the dog is on high dose prednisolone. There is a steroid-induced isoform of ALP.

18

Tx - cyclophosphamide-induced haemorrhagic cystitis

Glycosaminoglycans - help cover bladder lining Oxybutinin - relieve detrusor muscle spasm

19

When can you restart vincristine and another alylating agent (e.g. chlorambucil) after an episode of cyclophosphamide-induced haemorrhagic cystitis?

Repeat haematology and urinalysis in 3-5 days’ time. If the neutrophil count is >2.0x109/l or within normal range at this stage, restart vincristine and another alkylating agent (e.g. chlorambucil) should be introduced in place of cyclophosphamide.

20

What does this show?

Enlarged kidney Abdominal mass

21

Why is the CHOP protocol preferred over the COP protocol in feline renal lymphoma cases?

COP protocol would be suitable, however, with renal involvement, a COAP protocol would be preferred i.e. a protocol containing cytosine arabinoside. This is because cats with renal lymphoma sometimes develop CNS lymphoma and cytosine arabinoside (cytarabine) has good CNS penetration.

22

What is one of the major concerns, shortly after starting chemotherapy for alimentary lymphoma?

Gut perforation can occur as the tumour starts to die, causing peritonitis and death / euthanasia.

23

Outline prevalence of alimentary and mediastinal lymphoma in cats

Alimentary lymphoma is the most common presentation in older cats which are usually FeLV negative. Mediastinal lymphoma is more common in younger cats. In the past, many mediastinal cases were FeLV positive, however, following widespread vaccination, more FeLV negative cases occur nowadays.

24

Clinical signs - mediastinal lymphoma

dyspnoea, tachypnoea, cough, dysphagia, reduced lung sounds, displaced heart sounds, decreased compressibility of the cranial thorax and occasionally Horner’s syndrome.

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